title: Barriers to, and facilitators for, referral to pulmonary rehabilitation in COPD patients from the perspective of Australian general practitioners: a qualitative study.
abstract: BACKGROUND
  Pulmonary rehabilitation (PR) is recommended in the management of people with chronic obstructive pulmonary disease (COPD), but referral to this service is low.
  
  
  OBJECTIVE
  To identify barriers to, and facilitators for, referral to PR programmes from the perspective of Australian general practitioners.
  
  
  METHODS
  Semi-structured interviews were conducted with general practitioners involved in the care of people with COPD. Interview questions were informed by a validated behavioural framework and asked about participants' experience of referring people with COPD for PR, and barriers to, or facilitators of, this behaviour. Interviews were audiotaped, transcribed verbatim, and analysed using content analysis.
  
  
  RESULTS
  Twelve general practitioners participated in this study, 10 of whom had never referred a patient to a PR programme. Four major categories relating to barriers to referral were identified: low knowledge of PR for COPD; low knowledge of how to refer; actual or anticipated access difficulties for patients; and questioning the need to do more to promote exercise behaviour change. Awareness of benefit was the only current facilitator. Three major categories of potential facilitators were identified: making PR part of standard COPD care through financial incentive; improving information flow with regard to referrals and services; and informing patients and public.
  
  
  CONCLUSIONS
  Significant barriers to referral exist, but opportunities to change the organisation of practice and information management were identified. Behaviour change strategies which directly target these barriers and incorporate facilitators should make up the key components of interventions to improve referral to PR by general practitioners who care for people with COPD.
authors.affiliation: School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia.
authors.forename: Kylie N
authors.initials: KN
authors.lastname: Johnston
authors.forename: Mary
authors.initials: M
authors.lastname: Young
authors.forename: Karen A
authors.initials: KA
authors.lastname: Grimmer
authors.forename: Ral
authors.initials: R
authors.lastname: Antic
authors.forename: Peter A
authors.initials: PA
authors.lastname: Frith
mesh_terms: D001315:Australia; D002983:Clinical Competence; D005081:Exercise Therapy; D005260:Female; D058006:General Practice / Q000379:methods*; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D010818:Practice Patterns, Physicians'; D029424:Pulmonary Disease, Chronic Obstructive / Q000534:rehabilitation*; D036301:Qualitative Research; D012017:Referral and Consultation; D012138:Respiratory Therapy